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Health insurance, would you skip it?


Janeway
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Husband got the information on the insurance. It is $148 for us, each pay check, which means about $300 per month. THEN, it is $600 per month for the kids. OK..and THEN, it is a about $6400 out of pocket deductible before it starts to pay. Then once it starts to pay, it seems to be a copay plan, with then paying 70/30 after, we pay 30%, they pay 70. The copays are to the tune of $500 per ER visit, $40 per regular doctor visit, $70 per specialist visit, and then for tests, we pay a portion.

 

This is all to say, I am thinking maybe we should just skip the health insurance. For the kids at least. As it stands, they rarely go to the doctor. And= even if they have to go, it would cost a lot less than this. Short of something catastrophic, thinking this insurance is so expensive that we might be better off skipping it? Not sure. 

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Husband got the information on the insurance. It is $148 for us, each pay check, which means about $300 per month. THEN, it is $600 per month for the kids. OK..and THEN, it is a about $6400 out of pocket deductible before it starts to pay. Then once it starts to pay, it seems to be a copay plan, with then paying 70/30 after, we pay 30%, they pay 70. The copays are to the tune of $500 per ER visit, $40 per regular doctor visit, $70 per specialist visit, and then for tests, we pay a portion.

 

This is all to say, I am thinking maybe we should just skip the health insurance. For the kids at least. As it stands, they rarely go to the doctor. And= even if they have to go, it would cost a lot less than this. Short of something catastrophic, thinking this insurance is so expensive that we might be better off skipping it? Not sure. 

 

I have heard of plans you can buy for individual kids that would be cheaper than that.  I don't know any details, but in your shoes I would look into it.  That is a lot of money for essentially no insurance.

 

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Husband got the information on the insurance. It is $148 for us, each pay check, which means about $300 per month. THEN, it is $600 per month for the kids. OK..and THEN, it is a about $6400 out of pocket deductible before it starts to pay. Then once it starts to pay, it seems to be a copay plan, with then paying 70/30 after, we pay 30%, they pay 70. The copays are to the tune of $500 per ER visit, $40 per regular doctor visit, $70 per specialist visit, and then for tests, we pay a portion.

 

This is all to say, I am thinking maybe we should just skip the health insurance. For the kids at least. As it stands, they rarely go to the doctor. And= even if they have to go, it would cost a lot less than this. Short of something catastrophic, thinking this insurance is so expensive that we might be better off skipping it? Not sure.

I would not skip it. $900 per month for your largish family is not bad.

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I'm tempted, every year, but so far we've bought it. Have you called an insurance agent to see what you can buy? I know you hate the marketplace but....

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Have y'all never had a medical emergency? My husband, out of the blue, had a medical problem that landed him in the hospital for three weeks. $300 K later, we were very glad we had insurance. Dd had a minor skin infection that resulted in two surgeries (minor) and two hospital stays. My family is also very healthy, or at least we would have said that until these events. Get the insurance. I would cut out all sorts of things before I would cut health insurance. Cable, phone, you name it. You are one car accident or fall from financial disaster.

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Have y'all never had a medical emergency? My husband, out of the blue, had a medical problem that landed him in the hospital for three weeks. $300 K later, we were very glad we had insurance. Dd had a minor skin infection that resulted in two surgeries (minor) and two hospital stays. My family is also very healthy, or at least we would have said that until these events. Get the insurance. I would cut out all sorts of things before I would cut health insurance. Cable, phone, you name it. You are one car accident or fall from financial disaster.

 

In the OPs original post her insurance for that $300K situation you listed would still cost $17,200 + $90K (the 30% co pay part).  That's already financial disaster for most people I know.

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Although the insurance doesn't sound like a very good deal, one thing to keep in mind is that you likely won't be paying taxes on the salary that is used to pay your premiums. Depending on your federal tax bracket and state rates that could represent a very substantial discount on the premium costs.

 

I would be quite concerned about not having insurance, given that your husband will have a good paying job. If something catastrophic happens, they will likely expect you to pay.

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In the OPs original post her insurance for that $300K situation you listed would still cost $17,200 + $90K (the 30% co pay part).  That's already financial disaster for most people I know.

 

Except I have never heard of an insurance that didn't have an Out of Pocket Maximum that they would pay.  For most policies I have seen now, the OOP is 2x the deductible.  So $17,200 + $12,800, so right at $30,000 instead of $107,200.

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In the OPs original post her insurance for that $300K situation you listed would still cost $17,200 + $90K (the 30% co pay part). That's already financial disaster for most people I know.

There is a max out of pocket. 12k per person or family...but they wouldn't be paying 90k.

 

Also I think the co pays start immediately...you don't have to reach deductible to qualify for co pay.

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Have you checked to see if your children qualify for the CHIP program in the state (Medicaid for kids).  I would do that before I would forego insurance for kids.  Children break limbs, come down with appendicitis, need tonsils taken out, develop life threatening allergies, etc and that can all happen at the drop of a hat.  That's why CHIP programs were developed.

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Except I have never heard of an insurance that didn't have an Out of Pocket Maximum that they would pay. For most policies I have seen now, the OOP is 2x the deductible. So $17,200 + $12,800, so right at $30,000 instead of $107,200.

ACA sets a max out of pocket.

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There is a max out of pocket. 12k per person or family...but they wouldn't be paying 90k.

 

Also I think the co pays start immediately...you don't have to reach deductible to qualify for co pay.

 

Yes, and currently preventative care is usually covered at 100%.

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I'm tempted, every year, but so far we've bought it. Have you called an insurance agent to see what you can buy? I know you hate the marketplace but....

I hate the market place because it was not feasible for most people. Apparently, your income has to be between 100-140% of ..some amount..I do not recall what. If you are below or above that, you cannot buy from the market place. Or can't get subsidy to do it? Something like that. Regardless, we could not get from it when our income was too high and again could not when our income was too low.

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Have you checked to see if your children qualify for the CHIP program in the state (Medicaid for kids).  I would do that before I would forego insurance for kids.  Children break limbs, come down with appendicitis, need tonsils taken out, develop life threatening allergies, etc and that can all happen at the drop of a hat.  That's why CHIP programs were developed.

Our income is too high for chip too.

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There is a max out of pocket. 12k per person or family...but they wouldn't be paying 90k.

 

Also I think the co pays start immediately...you don't have to reach deductible to qualify for co pay.

 

Well, that's how my insurance is, but that's not what OP wrote.  She wrote the deductible had to be met before it would pay anything and she didn't say anything about a max OOP.  Maybe OP could clarify this point?

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Except I have never heard of an insurance that didn't have an Out of Pocket Maximum that they would pay.  For most policies I have seen now, the OOP is 2x the deductible.  So $17,200 + $12,800, so right at $30,000 instead of $107,200.

 

We have one.  I thought it was illegal, apparently not.  30% co-insurance, no maximum.  I verified it with both HR and BCBS.  The out of pocket maximum's applied to the Obamacare plans, not private insurance plans FWIW.  

 

It is really scary having insurance like this.  A heart attack could cost us 30k or more out of pocket.  But it's the insurance available through DH's work.

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I hate the market place because it was not feasible for most people. Apparently, your income has to be between 100-140% of ..some amount..I do not recall what. If you are below or above that, you cannot buy from the market place. Or can't get subsidy to do it? Something like that. Regardless, we could not get from it when our income was too high and again could not when our income was too low.

 

There were no income caps on buying from the marketplace, however if your income was high you would not receive any premium reductions.  

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We have one. I thought it was illegal, apparently not. 30% co-insurance, no maximum. I verified it with both HR and BCBS. The out of pocket maximum's applied to the Obamacare plans, not private insurance plans FWIW.

 

It is really scary having insurance like this. A heart attack could cost us 30k or more out of pocket. But it's the insurance available through DH's work.

I agree, it's awful insurance. But without it, what would a heart attack cost?

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Honestly it all confuses me... I took dd to the ER a couple months ago. We had not reached our deductible so I was expecting a huge bill. Well after I filled out and returned the accident report they said yes, it was adjusted and no, we don't owe that much. So that makes me think if we didn't have ins. we would have paid a lot more despite not having met the deductible?? Maybe sometimes it helps to have ins. for weird things like that. Also, I recently started taking a medication and I pay a very small fee for it. Otherwise I guess I couldn't afford it.

 

Dh has dd on his plan through work. I have my own plan. Ds has his own plan. We pay too much for insurance, but we've looked into combining to a family plan and it wouldn't be cheaper. We thought it would be, but after looking at the options again it's not.

 

Can you look into more insurance options? Surely there is another solution than skipping insurance?

 

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Don't skip health insurance.  Just don't.  

Get the coverage for you and your dh and see about private pay for the kids.  

 

 

At the very LEAST, go with catastrophic coverage with a deductible the highest amount you can afford without having to change your lifestyle.  We have a $10K deductible for 3 adults, $736 a month.

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Our income is too high for chip too.

 

In NH they have a CHIP Medicaid, but also a sliding fee scale for decent insurance for those children who don't qualify for the Medicaid.  You'd have to make a boatload of money to not qualify for their sliding scale insurance rates.  I suppose if you make a boatload of money you can afford the $600 per month for other insurance, or just pay the bills out of your pocket.

Edited by Amy in NH
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Honestly it all confuses me... I took dd to the ER a couple months ago. We had not reached our deductible so I was expecting a huge bill. Well after I filled out and returned the accident report they said yes, it was adjusted and no, we don't owe that much. So that makes me think if we didn't have ins. we would have paid a lot more despite not having met the deductible?? Maybe sometimes it helps to have ins. for weird things like that. Also, I recently started taking a medication and I pay a very small fee for it. Otherwise I guess I couldn't afford it.

 

Dh has dd on his plan through work. I have my own plan. Ds has his own plan. We pay too much for insurance, but we've looked into combining to a family plan and it wouldn't be cheaper. We thought it would be, but after looking at the options again it's not.

 

Can you look into more insurance options? Surely there is another solution than skipping insurance?

 

 

Generally the insurance companies negotiate a rate for their customers, which is lower than a cash payment.  One doctor we see charges $150 for a visit.  But our insurance has a negotiated rate that is about half of that.  That amount - the amount I pay - is then applied to our deductible.  It's the same for most prescriptions - we pay a lower cost than we'd pay if we had no insurance.  I think it shows up on the EoB as an adjustment.  

 

Of course I don't know if that's why your bill was lower than you expected, but it might have been. 

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Have y'all never had a medical emergency? My husband, out of the blue, had a medical problem that landed him in the hospital for three weeks. $300 K later, we were very glad we had insurance. Dd had a minor skin infection that resulted in two surgeries (minor) and two hospital stays. My family is also very healthy, or at least we would have said that until these events. Get the insurance. I would cut out all sorts of things before I would cut health insurance. Cable, phone, you name it. You are one car accident or fall from financial disaster.

 

Yeah, our car crash between hubby and I we had a half MILLION in medical bills.  Person at fault had no insurance.   Insurance is too important to skip.  BTW our monthly insurance cost is about $1,100 and we have similar co-pays, etc.  but I'd rather pay it and not need it than need it and not have it.

Edited by JFSinIL
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We currently have insurance at about $600 premiums for a family.  We have a $5250 deductible, with a $14,000 out of pocket max.

 

Next year, we are looking at Christian health sharing plans.  It's a lot, and it keeps me awake at night about the what-ifs.

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Don't skip it.  

 

My husband's colon ruptured with no advance warning about 7 years ago.  Emergency surgery, colostomy, and follow up surgeries resulted. Our pre-insurance bills were well over 300K.  We rarely use our high deductible insurance, and it is horrible about covering meds, but it was a financial life-saver that year.

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Another way to look at it might be this: how much out of pocket can you absorb before it would make more sense for you to just declare bankruptcy? 

 

Taking the example above of a $300K medical emergency that would cost you $107K out of pocket anyway, can you absorb $107K or would you end up declaring bankruptcy, even with the insurance? For us, with a modest home (I didn't pay $107K for my house) and a modest income, the idea that we could absorb $107K is LOL.  But someone with a higher income/assets might find it feasible, so it might be worth the really high premiums to keep the bill down.

 

For sure I would look to shop other avenues before deciding.  If you decide to forgo the insurance, I would negotiate a salary raise based on the fact that the employer won't be paying insurance (my dh's company pays over $10K per year for their part of our insurance, so an employee not taking the insurance is a real savings to the company,  I would want part of that).

 

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If it's at all a possibility, I wouldn't skip the health insurance.  I think (hope I'm right here) that medical bills are the #1 reason for bankruptsy filings.

 

OP, does this policy have a max out of pocket for the year? 

 

It usually only takes one medical event to make a lifetime of premiums worth it.

 

Best wishes as you decide.

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If it's at all a possibility, I wouldn't skip the health insurance. I think (hope I'm right here) that medical bills are the #1 reason for bankruptsy filings.

 

OP, does this policy have a max out of pocket for the year?

 

It usually only takes one medical event to make a lifetime of premiums worth it.

 

Best wishes as you decide.

I agree. And my dh's one event that could have cost us $300k but didn't thanks to insurance resulted in another long hospital stay that could've cost another $300k or more, plus ongoing meds and doctor's visits. You just don't know what's going to happen. Do shop around and see what's available though. If you all are healthy, you may qualify for some high deductible policy that's worth the risk.

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Husband got the information on the insurance. It is $148 for us, each pay check, which means about $300 per month. THEN, it is $600 per month for the kids. OK..and THEN, it is a about $6400 out of pocket deductible before it starts to pay. Then once it starts to pay, it seems to be a copay plan, with then paying 70/30 after, we pay 30%, they pay 70. The copays are to the tune of $500 per ER visit, $40 per regular doctor visit, $70 per specialist visit, and then for tests, we pay a portion.

 

This is all to say, I am thinking maybe we should just skip the health insurance. For the kids at least. As it stands, they rarely go to the doctor. And= even if they have to go, it would cost a lot less than this. Short of something catastrophic, thinking this insurance is so expensive that we might be better off skipping it? Not sure.

Please don't skip the health insurance.

 

Just because you have been lucky in the past doesn't mean that no one in your family will never become seriously ill or injured. Obviously, I hope you all stay perfectly healthy, but you just never know for sure, and it sounds like you can afford the premiums but simply don't want to pay them. I think it would be a very foolish decision to not have health insurance for your family. If you want to be thrifty, pick some other way to save money.

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I can't see your signature (if you have one), but I know you've mentioned a fifteen year old who is on the spectrum.

 

At some point you may want to have access to ABA or other therapies, which can be extremely expensive. Just as a guide, for us, 5 hours of ABA per week (the lowest time which was considered useful) was going to cost about $20,000/year. Thankfully, we had help covering it.

 

Whether insurance covers this varies by state, but it would be worth looking into. Appropriate therapy can make an enormous difference in a child's (and family's) life. It is useful for teens, as well as younger children. And, if it is covered, your insurance would instantly have proven worthwhile, before anyone ever develops the sniffles. Just one more reason to get the insurance.

Edited by Innisfree
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Don't skip it. Open an HSA and put the amount of the deductible in it, tax free, If you don't use it this year, it will be there waiting for you next year. There is a great deal of uncertainty surrounding how pre-existing conditions will be covered in the future. If one of you gets sick or injured while uninsured, it may be completely unaffordable for that person to be insured in the future.

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Maybe you could look into one of the medical health shares? We are generally very healthy and went without insurance for years hoping we'd never have a major medical event. We didn't even have the option of group policies. We were eligible for a marketplace plan with large subsidies, but they were still horribly expensive with large deductibles and co-pays and the lowest price plans weren't accepted at any of our many local hospitals or doctors. We joined a healthshare and my son just needed surgery for an unusual injury. We were able to go to any doctor and to the local children's hospital for the surgery (not an option with marketplace plans) and we won't be fined for being without insurance. I guess we'll be finding out as soon as the bills come in if the health share will live up to its promises, but doctor's offices and the hospitals accepted it without any fuss at all.

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Catastrophic came suddenly and unexpectedly in the form of a serious cancer to one of my young adult children, and I'd advise never going a single day without it if it is within your means. We hit the $1 million mark before the first month was up, $2 million by 9 months. (The hospital wrote off most of what the insurance didn't pay.)

 

Even several years down the road, one semi-annual appointment with labs run in the neighborhood of $25,000. 

 

I'd go without a lot of things before I'd go without insurance. 

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We have one. I thought it was illegal, apparently not. 30% co-insurance, no maximum. I verified it with both HR and BCBS. The out of pocket maximum's applied to the Obamacare plans, not private insurance plans FWIW.

 

It is really scary having insurance like this. A heart attack could cost us 30k or more out of pocket. But it's the insurance available through DH's work.

Mine is similar and I also have BCBS. We do have some sort of OOP maximum but I believe it's well over a hundred thousand dollars.

Several hundred a month plus $12,500 deductible then 30% copays. My oldest is diagnosed with autism but we got turned down for Medicaid waiver, so if I want to pursue any therapies it's pretty much all out of pocket.

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That's not that expensive for health insurance. My dh pays something like $300 a month just for him, and his income is low enough that we do qualify for Medicaid for dd. You're not going to find much cheaper, and you'll be glad you have it if there's a major medical thing, or if one of you gets put on a super expensive prescription.

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Yet another whose child's serious medical catastrophe would have not only bankrupted us forever, but quite possibly lost us the child due to lack of coverage for extremely expensive hospitalization...somebody might have treated him somehow? But I don't believe he would have received the level of care that saved his LIFE if we'd been indigent as far as insurance and ability to pay half a million dollars goes.

 

I would live on beans and rice in a ghetto apartment before I'd go without insurance for my children. If you have to do that in order to pay over $17000/yr for insurance, then that's what you do. But spend more time with the marketplace, research state plans for kids, look at other job opportunities, ALL that, before you give up and go without.

 

We need change, but in the meantime our children need insurance. They just do.

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We haven't always used our insurance but we always carried it. I personally would not be comfortable not carrying insurance. For me, it would feel highly irresponsible if I could possibly afford it.

 

Also, look at your plan details more. We have a deductible so I that had to be met before they paid anything. Turns out, most routine care and all of their ASD-related therapies are not subject to the deductible and are covered without us having to pay anything but the co-pay of $25.

Edited by LucyStoner
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